BRI9907443, E-Mail: marcovaz@esef.ufrgs.br Pedido.051028-673 Usuario Marco Vaz Phys Ther 1985 65(2) pags, 186-96 / Selkowitz OM / Improvement in isometric strength of the quadriceps femoris muscle after training with electrical stimulation, [(iah) MEDLINE_1966-1992 pmid 3871529] Fonte de referéncia'(iah) MEDLINE_1966-1992 pmid: 3871529 Prof Dr. Marco Aurelio Vaz Rua Mariz e Barros 392 Ap 501 '90690-390 - Porto Alegre - RS BRASIL BRI9907443 E-Mail: marcovaz@esef.ufrgs.br WAANNNY I Pedido:051028-573 ff Phys Ther / 1985 65(2) pags. 186-96/ Selkowitz DM / Improvement in isomnetrif strength of the quadriceps femoris muscle afer traning with Alectrical stimulation. [(iah) ME 3871629]Improvement in Isometric Strength of the Quadriceps Femoris Muscle After Training with Electrical Stimulation DAVID M. SELKOWITZ ‘The purpose of this investigation was to determine if training isometrically with electrical stimulation (ES) alone would significantly increase isometric strength of the quadriceps femoris muscle. The relationships between the strength changes and the relative force and duration of training contractions were also studied. An experimental group (Group 1) and a control group (Group 2), 12 ‘subjects in each, underwent pretesting and posttesting to obtain their maximum voluntary isometric contractions (MVICs). Group 1 trained with maximally tolerable isometric contractions induced by ES, three days a week for four weeks, Results showed that although both groups demonstrated increases in isometric strength of their quadriceps femoris muscles, training isometrically with ES produced a ‘significantly greater increase (p < .01) than not training with ES. The relative strength improvement in Group 1 was positively and significantly correlated with training-contraction intensity and duration. The relative increase in isometric strength, using only ES, may be determined by the ability of the subjects to tolerate ionger and more forceful contractions. Suggestions for further research and implications for the clinical use of ES for strength-training are discussed. Key Words: Electric stimulation, Muscle contraction, Physical therapy. ————————————— ees Exogenous electrical stimulation (ES) of nerve and muscle is used for muscle reeducation,' delay of atrophy.2" temporary reduction of spasticity.** and reduction of contractures® and edema.’ The use of ES for muscle strengthening in research and clinical practice has become increasingly popular in re- cent years. Training isometrically with ES is reported to increase isometric" and isokinetic”? quadriceps femoris ‘muscle strength in healthy subjects. Patients recovering from knee ligament surgery’ and patients with chondromalacia patellae'” have also shown increases in isometric strength of the quadriceps femoris muscle after ES training. Experimental procedures have been based in part on ES research of isomet- ric strength increases in the quadriceps femoris muscle of athletes by investigators in the Soviet Union (to date unpub- lished in the United States)" Several investigators have dem- onstrated the effects of ES training on muscle physiology.®"*"'* Munsat ct al demonstrated significant increases in muscle fiber size and changes in fiber type composition in the rectus femoris muscle of patients with contractured hamstrings after the use of chronic stimulation with implanted electrodes.” Stanish et al reported that ES training prevented a reduction in myofibrillar adenosine triphosphatase (ATPase) activity (associated with contractile force and speed) in the quadriceps femoris muscle of patients who had their knees immobilized Mr. Selowite i Staff Physical Therapist Sports Health and Preseason valuation Cener. Merit/Perata Medial Center, 2935 Teleeraph Ave, Osh lan CA 99609 (USA) He waa graduate sade in he prope fora Nasir ‘af Science in Physical Therapy at Sargent Collegeof Aled Health Proessons Boston Uaversty. Boston, MA. atthe be this study was condvcte “Tis projet was supported in pur with 2 grant fom the Dedey Alen Surpent Research Fund, This ace was submited March 28 1983; was withthe author for revision 39 wees and was acpi At 1984 196 after surgery.’ Laughman et a," Currier and Mann." Currier cet al!" and Massey etal!” demonstrated no significant differ- fences in strungth gains between groups training with ES and those training with only voluntary contractions. ‘Comparing studies and drawing valid conclusions concem- ing the use of ES is difficult because of inadequate standard ization of experimental procedures. Procedures involving an experimental group training with ES in addition to other forms of excreise,”” an experimental group receiving ES su perimposed on voluntary contractions,’ or an experimental ‘group receiving ES as the only method of exercise!" are Feported. Recent studies have compared groups training with ES with groups training with only voluntary contractions (VC), and with groups taining with ES superimposed on voluntary contractions (ESVC)."' Romero etal applied ES 10 the quadriceps femoris muscle bilaterally (simultaneously) and tested strength isometrically and isokinetically.” Halbach and Straus!” and Massey et al!” used dynamic testing modes to compare groups training isometrically with ES with those training dynamically without ES. Kots's notes.’ Johnson et al" and Halbach and Straus" did not report a control group for comparison with an ES group. In the literature on ES strength training, ES contractions have always been isometric: Of the previously mentioned studies, only Massey et al" applied ES to a muscle group other than the quadriceps femoris muscle. Other varying training factors include the frequency and period of training sessions and the duration, and intensity (relative force) of training contractions. Electri« cal stimulation factors of frequency, amplitude, pulse width, and waveform have also varied. Characteristics of the ES and the training protocol have not always been reported thor: oughly nor have either been well-controlled." PHYSICAL THERAPYThe purposes ofthis study were 1) to determine if isometric training with ES alone would significantly improve isometric {quadriceps femoris muscle strength; 2) to deterraine the cor- felation between strength changes and the intensity (relative force) and duration of training contractions; 3) 10 discuss the rationale for, and the possible effects of, the training protocol sed: 4) 10 note observations and subjective reports regarding the use and effects of an electrical stimulator in a strength- ning regimen, which may not be easily submitte to statistical nalyses: and 5) to determine if sex differences introduced & confounding variable. This study was completed in thesis form in the spring of 1982. At that time, no published study had \) included a control group to be statistically compared by an isometric Strength test with a group training with only isometric ES Contractions. 2) reported intensity of training contractions, oF 5) trained the ES group at near maximum intensities, Also, fo study had demonstrated that a group training with only isometric ES contractions could increase in isometric strength Significantly more than a control group. In stuclies published since 1982. Romero etal,” Laughman etal, ard Currier and Mann'' included a control group in the manner described above and showed significantly greater increases in the ES training eroup in comparison with the control group. In ‘dition, Laughman et al, Currier and Mann." and Owens and Malone'® reported the training contraction intensity. No esearch published to date, however, has had a group train ‘sith only ES contractions that approached the maximum Voluntary isometric contraction in intensity. Furthermore, no yeports have investigated the relationships be'ween strength ‘Changes and the intensity and duration of training contrac: ‘ions. METHOD Subjects ‘Twenty-four volunteers, 8 men and 16 women, Were se tected from Boston University students and faculty. Ages ranged from 18 to 32 years (X = 24.6). Criteria for selection included 1) absence of neurological and orthopedic impair- ‘ments and 2) no strength training for at least four weeks before the investigation, Design The experimental design included a prevest, a training program, and a posttest of subjects im an experimental group (Group 1) and a control group (Group 2). Pretest Procedure Isometric torque, used as an index of knee extensor (quad riceps femoris muscle) strength, was measured with a Cybex TT isokinetic dynamometer.” All subjects pavticipated in the preest procedure to determine their maximum voluntary isometric contraction (MVIC). Subjects were positioned on the Cybex" chair with stabilization supports across the pelvis and distally over the thigh (Fig. 1). For additional stabiliza- tion. the subjects gnipped the sides of the chair and leaned tuck against the backrest, which was inclined posteriorly to Pet Division of Lames Ine, 2700 Smithiown A, Ronkonkoma, NY Volume 65 / Number 2, February 1985 Fig. 1. Subject positioning on the Cybex* chair during testing and waning an angle of 70 degrees above horizontal. The axis of rotation Ofthe Cybex” lever arm was aligned with the axis ofthe knee Joint, The knee was fixed at 60 degrees of flexion, and the Cybex” speed-sclector was set at O°/sec. Williams and Stutz- rman found that isometric knee extensor torque was greatest at this angle. The distal end of the lever arm was securely fastened proximal to the malleoli, Subjects were instructed Geithout verbal encouragement) to extend the knee with as much force as possible and to maintain the contraction until instructed to relax (10 seconds). Three trial contractions were performed, with a two-minute rest interval between contrac lone, The mean torque value of the three pretest trials was chosen as the MVIC. Training Procedure Subjects were randomly assigned 10 Group 1 or Group 2. Each group consisted of four men and eight women, Group 1 engaged in an isometric strength-training regimen of clec- Ircally stimulated isometric contractions of the quadriceps femoris muscle. The subjects were instructed not to add a voluntary component to the electrically stimulated contrac: 187